These recommendations are consistent with Guidelines on the management of cellulitis, published by the Clinical Resource Efficiency Support Team on the management of cellulitis [CREST, 2005]. They are pragmatic in nature and aim to ensure that people with potentially serious cellulitis, or people who are particularly vulnerable to infection, receive the treatment they need in secondary care.

• Most people who are admitted to secondary care will require intravenous antibiotics.
• Severe localized infection, or systemic features (which may indicate the development of bacteraemia) can be life threatening (for example if they progress to necrotizing fasciitis).
• Certain groups (e.g. the very young and old, and people with comorbidities) are more vulnerable to life-threatening infection, so require a lower threshold for admission.
• People with cellulitis affecting anatomical areas where the consequence of tissue damage would be particularly critical (for example facial erysipelas) require immediate assessment.
• CKS recommends that people who do not respond to oral antibiotics, or who have frequent recurrence of cellulitis, should be referred to the appropriate department where they can:
• Be assessed further to confirm the diagnosis of cellulitis (referral to dermatology is appropriate if the diagnosis is in doubt).
• Receive intravenous or prophylactic antibiotic treatment if necessary (referral to general medicine or outpatient parenteral antimicrobial therapy service, where available, is appropriate).